partial birth abortion

Abortion, partial birth

Definition

Partial birth abortion, medically known as intact dilation and extraction (IDX), is a method of late-term abortion that ends a pregnancy and results in the death and intact removal of a fetus from the uterus. In the United States, as of late 2008 the procedure was illegal.

Purpose

Partial birth abortion, or IDX, is performed to end a pregnancy in the mid to late second trimester. It is typically performed between weeks 19 and 26 of pregnancy. IDX is highly controversial. Some physicians argue that IDX has advantages that make it preferable to other late-term abortion procedures in some circumstances. One advantage is that the fetus is removed largely intact, allowing for better evaluation and autopsy of the fetus in cases of fetal abnormalities. Intact removal of the fetus also may carry a lower risk of puncturing the uterus or damaging the cervix. Another perceived advantage is that IDX ends the pregnancy without requiring the woman to go through labor. This may reduce the emotional trauma of ending the pregnancy when compared to other methods of late-term abortion. In addition, IDX may offer a lower cost and shorter procedure time. Regardless of any perceived advantages, the procedure is illegal in the United States. Even before the procedure became illegal, it was performed only rarely.

Legal Controversies

Before 2003, the legality of IDX rested with each individual state. In 2003, U. S. President George W. Bush signed into law the federal Partial-Birth Abortion Ban Act banning partial birth abortions nationwide and implementing fines or jail terms for physicians who perform them. A federal judge then declared the law unconstitutional, so that the government was not able to enforce it. A series of court battles over the constitutionality of the law continued until 2007. One legal issue centered on the fact that the legislation did not provide for exceptions in life-threatening cases where the procedure was needed to protect the mother's health. Another issue was the breadth and scope of the definition of partial-birth abortion. Three federal appeals courts ruled that the law was unconstitutional. Nevertheless, in April 2007, the U. S. Supreme Court upheld the law, ruling that it was constructional, thus allowing for its enforcement.

Precautions

IDX is currently illegal in the United States. Women considering IDX in countries where the procedure is legal should be aware of the highly controversial nature of this procedure. One controversy common to this and all late-term abortions is determining at what point in the pregnancy the fetus is viable (able to survive outside the mother' body). In technologically advanced countries, fetuses generally are viable at 28 weeks of pregnancy; some fetuses as young as 24 weeks survive. Another area of controversy specific to IDX is that fetal death does not occur until after most of the fetus's body has exited the uterus. Because of these concerns, many physicians who perform abortions do not perform IDX; this tends to limit the availability of the procedure.

Description

IDX first involves administration of medications to cause the cervix to dilate. Dilation usually occurs over the course of several days. Next, the physician rotates the fetus to a footling breech position. The body of the fetus is then drawn out of the uterus feet first, until only the head remains inside the uterus. The physician then uses an instrument to puncture the base of the skull, which collapses the fetal head. Typically, the contents of the fetal head are then partially suctioned out, which results in the death of the fetus and reduces the size of the fetal head enough to allow it to pass through the cervix. The dead but otherwise intact fetus is then removed from the woman's body.

Preparation

Medical preparation for IDX involves an outpatient visit to administer dilation medications such as laminaria. Psychological preparation is desirable.In addition, preparation may involve fulfilling local legal requirements, such as a mandatory waiting period, counseling, or an informed consent procedure reviewing stages of fetal development, childbirth, alternative abortion methods, and adoption.

Aftercare

IDX typically does not require an overnight hospital stay. A follow-up doctor's visit usually is scheduled to monitor the woman for any complications.

Risks

With all abortion, the later in pregnancy an abortion is performed, the more complicated the procedure and the greater the risk of injury to the woman. In addition to associated emotional reactions, IDX carries the risk of injury to the woman, including heavy bleeding, blood clots, damage to the cervix or uterus, pelvic infection, and anesthesia-related complications. There also is a risk of incomplete abortion, meaning that the fetus is not dead when removed from the woman's body. Possible long-term risks include difficulty becoming pregnant or carrying a future pregnancy to term.

Normal results

The expected outcome of IDX is the termination of a pregnancy and death of the fetus.

Key Terms

Cervix

The narrow outer end of the uterus that separates the uterus from the vaginal canal.

Footling breech

A position of the fetus while in the uterus where the feet of the fetus are nearest the cervix and will be the first part of the fetus to exit the uterus, with the head of the fetus being the last part to exit the uterus.

Laminaria

A medical product made from a certain type of seaweed that is physically placed near the cervix to cause it to dilate.

Symbolism, of course, counts for a lot in the abortion debate, which explains why Santorum and his supporters pushed so hard for a partial birth abortion ban, while opponents put so much energy into fighting it.

Even the Times, which only the day before had editorially lambasted the American Medical Association for trying to prohibit partial birth abortion, could not entirely sanitize or euphemize the procedure.

None of these clinical details are in the bill itself, which defines a partial birth abortion as one in which the doctor ``partially vaginally delivers a living fetus before killing the fetus and completing the delivery.

While it is true that partial birth abortion is banned by the federal law, the state partial birth abortion ban allows for enforcement of the law by state prosecutors-not just federal officials," said Balch.

Carhart, where Kennedy concluded, "Nebraska's ban on partial birth abortion furthers purposes States are entitled to pursue" and that "Nebraska was entitled to find the existence of a consequential moral difference between the [D&X and D&E] procedures.

On June 4, 2003, the Globe ombudsman, Christine Chinlund, wrote to inform NRLC that new internal guidelines had been adopted, among these, "the Globe would not say or imply that the procedure known as partial birth abortion is used only when medically necessary - - thus recognizing that [it] is also used by healthy women who carry a healthy fetus.

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